Propofol Sedation during Endoscopic Procedures: Safe and Effective Administration by Registered Nurses Supervised by Endoscopists

Background and Study Aims: Propofol has several attractive properties, including a rapid onset of action and rapid recovery. However, the administration of propofol sedation in the absence of anesthesiologists remains controversial. This report describes the safety profile of propofol sedation for endoscopy when administered by registered nurses under the supervision of endoscopists.
Patients and Methods: The study was conducted in the endoscopic center of a Japanese private hospital. With assistance from an anesthesiologist, a protocol for administration of propofol by registered nurses was developed. Over the past 6 years, 27 500 patients received nurse-administered propofol sedation. The safety and patient satisfaction with this sedation procedure were evaluated.
Results: Among the participating patients, 6.7 % developed hypoxemia (Spo₂ < 90 %); 6.2 % required oxygen administration via a nasal cannula. Severe hypoxemia (Spo₂ < 85 %) occurred in 121 patients (0.62 %) during upper gastrointestinal endoscopy and 20 patients (0.25 %) during colonoscopy, but neither mask ventilation nor endotracheal intubation was necessary. A decline in blood pressure (systolic blood pressure < 90 mm Hg) was seen in 3.5 % of the colonoscopy patients and 1.2 % of the upper endoscopy patients. However, hypotension was corrected immediately using an intravenous saline solution. Patients who received propofol sedation expressed overall satisfaction on a 10-point visual analogue scale (with an average of 9.4 points). Among patients who had previously received a combination of midazolam and pethidine for colonoscopy, 85 % preferred propofol sedation. The mean time from the end of the procedure to full recovery was 14.6 min.
Conclusions: Administration of propofol by registered nurses under the supervision of endoscopists was safe, and resulted in high rates of patient satisfaction.

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